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By Julia Serano
The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been called the “bible of mental illness” because it lists and defines all of the “official” psychiatric diagnoses according to the American Psychiatric Association. The DSM is in the early stages of undergoing its 5th major revision; each previous revision has seen the total number of mental disorders recognized (some might say invented) by the APA greatly increase. Last year, trans activists were particularly concerned to learn that Ken Zucker and Ray Blanchard had been named to play critical lead roles in determining the language of the DSM sections focusing on gender and sexuality, especially given that these researchers are well known for forwarding theories and therapies that are especially pathologizing and stigmatizing to gender-variant people.Blanchard has recently presented some of his suggestions to revise the “Paraphilia” section of the DSM. In the past, this section has generally received little attention from feminists, as it has been primarily limited to several sexual crimes (e.g., pedophilia, frotteurism and exhibitionism) and a handful of other generally consensual but unnecessarily stigmatized sexual acts (such as fetishism and BDSM) that are considered “atypical” by sex researchers. However, there are two aspects of the proposed Paraphilia section revision that should be of great concern to feminists, as well as anyone else who is interested in gender and sexual equality.Expanding “Paraphilia”
First, Blanchard is proposing a significant expansion of the DSM’s definition of “paraphilia” to include:
“any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, consenting adult human partners.”
The first concern here is the term “phenotypically normal” (meaning “normal” with regards to observable anatomical or behavioral traits). Thus, according to this definition, attraction to any person deemed by sex researchers to be “abnormal” or “atypical” could conceivably be diagnosed as paraphilic. So, do you happen to be attracted to, or in a relationship with, someone who is differently-abled or differently-sized? Or someone who is gender-variant in some way? Well congratulations, you may now be diagnosed with a paraphilia!
Seriously.

Blanchard and other like-minded sex researchers have coined words like Gynandromorphophilia (attraction to trans women), Andromimetophilia (attraction to trans men), Abasiophilia (attraction to people who are physically disabled), Acrotomophilia (attraction to amputees), Gerontophilia (attraction to elderly people), Fat Fetishism (attraction to fat people), etc., and have forwarded them in the medical literature to denote the presumed “paraphilic” nature of such attractions. This tendency reinforces the cultural belief that young, thin, able-bodied cisgender women and men are the only legitimate objects of sexual desire, and that you must be mentally disordered in some way if you are attracted to someone who falls outside of this ideal. It’s bad enough that such cultural norms exist in the first place, but to codify them in the DSM is a truly terrifying prospect.
Another frightening aspect of Blanchard’s proposal is that any sexual interest other than “genital stimulation or preparatory fondling” is now, by definition, a paraphilia. In his presentation, he claimed that paraphilias should include all “erotic interests that are not focused on copulatory or precopulatory behaviors, or the equivalent behaviors in same-sex adult partners.” Copulatory is defined as related to coitus or sexual intercourse (i.e., penetration sex). So, essentially, all forms of sexual arousal and expression that are not centered around penetration sex may now be considered paraphilias.
So, do you and your partner occasionally role-play or talk dirty to one another over the phone? Or engage in arousing play that is not intended to necessarily lead to “doing the deed”? Do you masturbate? Do you get a sexual charge from wearing a particularly sexy outfit or performing any act that falls outside of “genital stimulation or preparatory fondling”? Well, then congratulations, you can be diagnosed with a paraphilia!
“Transvestic Disorder,” Gender Inequality and the Sexualization of Feminine Gender Expression
Blanchard also wants to retain (with minor tweaking) the “Transvestic Fetishism” diagnosis from the previous DSM Paraphilia section; the new diagnosis is to be called “Transvestic Disorder.” Like it’s predecessor, it applies to “heterosexual males” who experience “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.” As Kelly Winters of GID Reform Advocates points out:
“Curiously, women and gay men are free to wear whatever clothing they chose without a label of mental illness. This criterion serves to enforce a stricter standard of conformity for straight males than women or gay men. Its dual standard not only reflects the social privilege of heterosexual males in American culture, but promotes it. One implication is that biological males who emulate women, with their lower social status, are presumed irrational and mentally disordered, while biological females who emulate males are not. A second implication stereotypically associates femininity and cross-dressing with male homosexuality and serves to punish straight males who transgress this stereotype.”
The “heterosexual male” nomenclature should also be of concern to many trans women, as Blanchard (and like-minded psychologists) routinely mis-describe lesbian-identified trans women as “heterosexual male transsexuals” in the medical literature. Since the Transvestic Disorder diagnosis does not explicitly exempt transsexuals, then a queer-identified trans woman (such as myself) could theoretically be diagnosed as having “Transvestic Disorder” any time that I have *any kind* of sexual urge while wearing women’s clothing. Since I wear women’s clothing pretty much every day of my life these days, my sexuality would presumably be considered perpetually transvestically disordered according to this diagnosis.
Kelley Winters has also written at length about how the vagueness of Transvestic Fetishism/Disorder wording enables the diagnosis of individuals who do not experience any sexual arousal in association with wearing women’s clothing. She argues:
“It serves to sexualize a diagnosis that does not clearly require a sexual context. Crossdressing by males very often represents a social expression of an inner sense of identity. In fact, the clinical literature cites many cases, considered diagnosable under transvestic fetishism, which present no sexual motivation for cross-dressing and by no means represent fetishism.”
We live in a heterosexual-male-centric culture, where femaleness and feminine gender expression are routinely sexualized, and where sexual symbolism is projected onto women’s clothing. For this reason, people (including psychologists such as Blanchard) regularly sexualize trans women, male crossdressers, and others on the trans feminine spectrum, and attribute sexual motives to us, even when no such motives exist. Thus, the Transvestic Disorder diagnosis both sexualizes people on the trans feminine spectrum, while simultaneously reinforcing the societal sexualization of women and feminine gender expression more generally.Sexism and the DSM Paraphilia Section
Proponents of the DSM Paraphilia section would argue that paraphilia diagnoses are only applicable when the individual in question exhibits “significant distress or impairment” over their sexual urges. This ignores the fact that many happy and healthy individuals are sometimes diagnosed with paraphilias. Further, the mere fact that Transvestic Fetishism, Masochism and Sadism have been listed in the DSM (under the same category as several nonconsensual sexual crimes, no less) is regularly cited by those who wish to delegitimize or legally discriminate against male crossdressers and people who practice consensual BDSM. Labeling any form of gender or sexual expression as a “mental disorder” is necessarily stigmatizing and ignores the vast amount of gender and sexual variation that exists in the world.
It was not that long ago that Homosexuality and Nymphomania were listed in the “Sexual Deviation” (which was later renamed “Paraphilia”) section of the DSM. They were removed, in part, due to public pressure, as both diagnoses only served to reinforce cultural double standards (i.e., the idea that same-sex attraction is less legitimate that heterosexual attraction, and that women should exhibit less sexual interest than men, respectively). We have a word to describe double standards that exist with regards to sex, gender or sexuality–it’s called sexism.
The proposed revision of the DSM Paraphilia section is sexist in numerous ways. We, as feminists, should fight to have *all* forms of sexual expression that occur between consenting adults removed from the DSM entirely. And we should especially fight for the removal of “Transvestic Disorder” on the grounds that it sexualizes feminine gender expression and reinforces rigid cis-hetero-male-centric gender norms.What you can do to help:
1) raise awareness about this issue in feminist circles.
2) contact the American Psychiatric Association and share your concern with them.
3) if you live in the San Francisco Bay Area, please come out to the protest of the upcoming American Psychiatric Association conference on Monday, May 18th between 6:00pm to 7:30pm in front of the Moscone Center. This protest will focus primarily on the removal of the trans-focused DSM diagnoses Gender Identity Disorder (GID) and Transvestic Disorder. While the GID diagnosis is of great concern to trans activists (including me), I did not discuss it here because it is not listed as a Paraphilia, and because (to the best of my knowledge) no information has been released regarding proposed revisions to GID in the next DSM.
For more information about the Paraphilia section of the DSM, I encourage you to read DSM-IV-TR and the Paraphilias: An Argument for Removal by Charles Moser and Peggy J. Kleinplatz.
For more info about “Transvestic Disorder,” check out Transvestic Disorder and Policy Dysfunction in the DSM-V by Kelly Winters. (Also, her blog and book provide excellent critiques of both the Transvestic Disorder and GID diagnoses).Julia Serano is an Oakland, California-based writer, spoken word performer, trans activist, biologist, and author of Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity.

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